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• W2130630382 abstract "<h3>Introduction</h3> Detection of peripheral pulmonary lesions (PPLs) is on the rise but an accurate means of obtaining a tissue diagnosis without high risk of complications is lacking.¹ Virtual bronchoscopic navigation (VBN) guides the bronchoscope under direct vision and, in combination with radial endobronchial ultrasound (R-EBUS) or ultrathin bronchoscopy, may enhance the diagnostic yield of PPLs with a minimal complication rate.² <h3>Aims</h3> To pilot the use of VBN in the diagnosis of PPLs. To identify patient and lesion characteristics that predict successful VBN. <h3>Methods</h3> Images from chest CT (slice width 1–1.25 mm) were acquired from patients, and lesion features, including location and presence of a bronchus sign (bronchus contained within PPL), were recorded. CT images were transferred to a portable workstation and Lungpoint Broncus © was used to create a virtual pathway to the PPL. Bronchoscopy was performed with VBN followed by R-EBUS guidance, under conscious sedation, and biopsies obtained. Pre-procedure characteristics, biopsy adequacy, biopsy outcome, 30-day follow up and complications were recorded. <h3>Results</h3> The median age of our cohort (n = 7) was 79 and all patients had one or more comorbidities. PPL median size was 28 mm and all were located in sub-segmental bronchi. VBN guided the operator to the correct site in six cases. Adequate biopsies were taken from five patients; four had a positive bronchus sign. Three adequate biopsies received a diagnosis of primary lung cancer; those remaining were negative. One patient with inadequate biopsies underwent transthoracic needle biopsy (TTNB) and was diagnosed with primary lung cancer. No complications occurred in spite of the significant co-morbidity of this patient cohort. <h3>Discussion</h3> Our preliminary data suggest that in a selected patient cohort with a bronchus sign, VBN may be a useful and safe adjunct to R-EBUS to obtain a tissue diagnosis from PPLs. In contrast, TTNB has a high diagnostic sensitivity but is tarnished by a high complication rate and is not suitable in patients with significant co-morbidity. Therefore, VBN and R-EBUS are particularly useful where TTNB carries a high risk. <h3>References</h3> 1 Kikuchi E, Yamazaki K, Sukoh N, <i>et al</i>. Endobronchial ultrasonography with guide-sheath for peripheral pulmonary lesions. <i>Eur Respir J</i> 2004;<b>24</b>:533–7 2 Ishida T, Asano F, Yamazaki K, <i>et al</i>. Virtual bronchoscopic navigation combined with endobronchial ultrasound to diagnose small peripheral pulmonary lesions: a randomised trial. <i>Thorax</i> 2011;<b>66</b>:1072–7" @default.
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• W2130630382 title "Benign neurogenic amyotrophy in Klinefelter's syndrome." @default.
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• W2130630382 doi "https://doi.org/10.1136/jnnp.57.5.640" @default.
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